DKA

My sister-in-law and a friend I met at a diabetes conference were both recently dealing with DKA.  Both were caused by lack of insulin.  One was because of not hooking her pump back up while dealing with sickness and the other had a bad batch of insulin.  DKA can happen to anyone.  There is a lot of misinformation out there on so many things related diabetes.  I think I'm going to take this week for some education awareness.  My sister-in-law spent an overnight in ICU and a little time in the hospital.  My friend was able to get some treatment at the hospital and work towards regulating back at home.  One of the EMTs that moved my sister-in-law from the health clinic to the hospital said she was diagnosed with Type 1 at 13 and at 18 thought she knew it all.  She ended up in DKA 9 times that year.  One thing I gleaned from my sister-in-law's experience is that DKA won't necessarily look like it did at Sugar Bear's diagnosis.  It's still scary, but I don't have to be afraid.  This was the first time in 13 years for my sister-in-law experiencing this.  It's awful, and Sugar Bear felt bad for his Aunt.  He got it.  I'm still learning.  I'm so grateful for medical breakthroughs that allow DKA to be corrected.  It used to always be a death sentence.

http://www.nlm.nih.gov/medlineplus/ency/article/000320.htm

 Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.

When fat breaks down, waste products called ketones build up in the body.

Causes

As fat is broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis.
Diabetic ketoacidosis is often the first sign of type 1 diabetes in people who do not yet have other symptoms. It can also occur in someone who has already been diagnosed with type 1 diabetes. Infection, injury, a serious illness, missing doses of insulin shots, or surgery can lead to diabetic ketoacidosis in people with type 1 diabetes.
People with type 2 diabetes can also develop ketoacidosis, but it is less common. It is usually triggered by uncontrolled blood sugar or a severe illness.

Symptoms

Common symptoms can include:

• Decreased alertness
• Deep, rapid breathing
• Dry skin and mouth
• Flushed face
• Frequent urination or thirst that lasts for a day or more
• Fruity-smelling breath
• Headache
• Muscle stiffness or aches
• Nausea and vomiting
• Stomach pain

Exams and Tests

Ketone testing may be used in type 1 diabetes to screen for early ketoacidosis. The ketones test is usually done using a urine sample or a blood sample.
Ketone testing is usually done:

• When the blood sugar is higher than 240 mg/dL
• During an illness such as pneumonia, heart attack, or stroke
• When nausea or vomiting occur
• During pregnancy

Other tests for ketoacidosis include:

• Amylase blood test
• Arterial blood gas
• Blood glucose test
• Blood pressure measurement
• Potassium blood test

This disease may also affect the results of the following tests:

• CO2
• Magnesium blood test
• Phosphorus blood test
• Sodium blood test
• Urine pH

Treatment

The goal of treatment is to correct the high blood sugar level with insulin. Another goal is to replace fluids lost through urination, loss of appetite, and vomiting if you have these symptoms.
If you have diabetes, it is likely your health care provider told you how to spot the warning signs of DKA. If you think you have DKA, test for ketones using urine strips or your glucose meter. If ketones are present, call your health care provider right away. Do not delay. Follow any instructions you are given.
Most of the time, you will need to go to the hospital. There, you will receive insulin, fluids and other treatment for DKA. Then doctors will find and treat the cause of DKA, such as an infection.

Outlook (Prognosis)

If DKA is not treated, it can lead to severe illness or death.

Possible Complications

• Fluid buildup in the brain (cerebral edema)
• Heart attack and death of bowel tissue due to low blood pressure
• Kidney failure

When to Contact a Medical Professional

DKA is often a medical emergency. Call your health care provider if you notice symptoms of DKA.
Go to the emergency room or call the local emergency number (such as 911) if you or a family member with diabetes have:

• Decreased consciousness
• Fruity breath
• Nausea
• Trouble breathing
• Vomiting

Prevention

If you have diabetes, learn to recognize the signs and symptoms of DKA. Know when to test for ketones, such as when you are sick.
If you use an insulin pump, check often to see that insulin is flowing through the tubing. Make sure the tube is not blocked, kinked or disconnected from the pump.